Changes occurring in the healthcare environment require healthcare delivery systems to provide high quality care services with increased efficiency and cost-effectiveness. Healthcare systems are encouraged to use less expensive care providers for medical management responsibilities while maintaining or increasing quality of patient care. Accompanying the changes in healthcare delivery modes is the parallel rise in patient acuity levels related to chronic illnesses of patients admitted for cardiac services such as cardiovascular surgeries. This retrospective, 2-group comparison study examined patient and economic outcomes between 2 groups of adult patients for whom postoperative cardiovascular care was directed by either cardiovascular surgeons alone or cardiovascular surgeons in collaboration with acute care nurse practitioners. Outcome measures included length of stay and cost for an episode of care. Findings revealed that when cardiovascular surgeons, in collaboration with acute care nurse practitioners, directed postoperative care, the length of stay decreased 1. 91 days and total cost decreased 5,038.91 dollars per patient.
The quality of life of 51 elderly subjects enrolled in cardiac rehabilitation is described to devise strategies for improving QOL as an outcome of a therapeutic regimen. Based on Chrisman and Fowler's Systems-in-Change Model, physical function, social function, and emotional function were assessed via the McMaster Health Index Questionnaire and the Cantril Self-Anchoring Scale during participation in cardiac rehabilitation. The greatest benefit of cardiac rehabilitation to subjects was in physical function, but benefits were also noted in social and emotional function.
Nurses in the NICU are relatively satisfied with their jobs. The small sample size (n = 109) of Midwest NICU nurses proves to be a limitation for generalization. Additional research is needed to further evaluate nursing role, educational level, and job satisfaction in the NICU.
hls. Miers is assistant ~I O~K S S O I -a t thr University of Alabania School 0 1 Nursing, University of Alahania ;it Rirtiiinghani. She teaches advaticed cardiovascrrlai-nursing atttl coordinates the issues in adv;inced nursing practice course in thr Master's program. She is also a tloctoral student at the University of Alabama School o f Nursing. and her dissertation interest is the application o f the Roy Adaptation Model t o the deductive developnient of a taxonomic structure for huinan r-esponses t o health conditions. Ms. Miers is a fortner inemher of the Board of Directors of the American Assoriation of Critical-Care Nurses. . Because of the working nature ofthe definition, ineiit1)c.i.s arid nonnienihers of the Association were invited t o judge the merits and faults of the definition and to recommend areas needing further debate, analysis, or rncdification. The purpose of this article is t o apply priiiciples and rilles of definition to an analysis of the working definition o f nursing diagnosis :is adopted by the NANDA General Asseinhly. In presenting this ani~lysis. concerns and questions regitrding the conceptual, logical. and granirnatic:i1 clarity o f essential elements (e.g., clinical judhment; individual. fantily. o r community responses: actual or potential healtli prohlems; and actual o r POtential life processes) in the definition are posed; and, where appropriate. suggestions for clarification are offered. Further debate, research, and clinical testing is requested in an attenipt t o improve NANDA's veilj impcwcant contribution to the development o f nursing practice theory.
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